Women and health insurance -- is gender a 'pre-existing condition'?

Women and health insurance

Is gender by itself a pre-existing condition?

April 27, 2011
State exchanges
What is an exchange?
Shopping the exchanges
Consumer protections
State exchanges
Essential benefits in ACA
The federal exchange
Will you get a subsidy?
Will you owe a penalty?
Cost-sharing subsidies
Types of exchanges
Exchange FAQs

Price check
health insurance
near you

Imagine being 55 years old with debilitating migraines, rheumatoid arthritis, caring for a husband in renal failure – and being unable to get individual insurance because you’ve had a hysterectomy. Your insurance carrier has flagged the hysterectomy as a pre-existing condition.

Or imagine hearing the words “You have cancer,” then finding a note in your mailbox notifying you that you’ve been denied coverage of potentially life-saving treatments because you failed to report a case of acne. Both of these scenarios are real-life stories. You’ll find them – and a litany of other horror stories about gender-related discrimination – on the National Organization of Women’s Web site.

Health reform advocates optimistically assure us that the vast number of horror stories is on the decline already, and that 2014 will mark the beginning of the end for many of these stories when a host of provisions within the Affordable Care Act take effect. But in years past – and until those provisions take effect – women’s lack of access to affordable health insurance has been disappointing and sometimes, deadly.

Gender-specific barriers abound

Every day, in every state, women face daunting challenges when it comes to the individual health insurance market: higher premiums than men for identical coverage, excluded coverage for gender-specific issues, and rejected applications based on the status: “survivor of domestic violence.”

Those were the findings of two recent reports from the National Women’s Law CenterNowhere to Turn: How the Individual Health Insurance Market Fails Women, and Still Nowhere to Turn: Insurance Companies Treat Women Like a Pre-Existing Condition were based on analysis of information from thousands of individual health insurance plans offered to individuals, families and small businesses.

Among the many findings:

  • Gender rating is practiced by all the best-selling plans in all states, even when maternity care is excluded.
  • Maternity care actually is excluded by nearly 90 percent of the plans in the individual health insurance policy market.
  • In the capital cities of all states, more than 60 percent of the plans charge a 40-year-old, non-smoking woman a higher rate than males who use tobacco. How much more? Well, each person is at the mercy of their city or state – the variance fluctuated from 1 percent more in Oklahoma City to 63 percent more in Little Rock.

Gender rating also exists in the group health insurance market, where it is legal to set premiums based on the number of women employees. To date, 15 states have laws forbidding gender rating, but the ban only applies at companies with 50 or fewer employee members. The discriminatory practice is completely permissible in moderate-sized to larger groups.

Age aggravates gender inequities

aging-women-and-insuranceOlder women are even greater targets, says Pamela Nadash, assistant professor at the University of Massachusetts’ Gerontology Department, because they tend generally to be less educated, but face a complex health care system.

“When you are talking about women over 65, there is a real market difference in terms of education, which puts these people at a great disadvantage,” she says. “Assessing health insurance information and making sense of it all is complicated for any one. But these are people who often have a hard time knowing how to take their medications.”

“On average, they have a choice of 33 Medicare Part D prescription drug plans, alone,” says Nadash, “and they have little support to help them make informed choices, not to mention the answers they get vary. Imagine being in this situation and trying to find the right plan.”

Where to look for help

Nadash advises older women to visit their area agency on aging for guidance in navigating the system, to find out what resources are out there for them. Though in many regions these agencies’ resources are limited.

Lisa Codispoti, senior counsel at NWLC, has limited advice to offer women in general. “Most states allow insurers to discriminate against women for gender-related status and health issues. So until 2014 when the law changes, they have little recourse.”

“If a woman is denied maternity care, for instance, unless she can qualify for Medicaid or employer coverage, she is out of luck,” Codispoti says. “In fact, most women who are already pregnant can not buy coverage in the individual market because it is considered a pre-existing condition.”

Codispoti defers consumers to state insurance departments, where consumers can call with problems regarding their insurance company.

“But for now,” she says, “gender discrimination is legal.”

There is a light at the end of the tunnel – and that light comes from health reform provisions, including one that would prohibit gender rating, starting in 2014.

“Health status rating will be prohibited,” Codispoti says. “It will be impermissible to reject people for coverage due to a pre-existing condition, and plans sold in the new exchange must cover a number of health care services important to women, including maternity care and prescription drugs.”

Tags: breast cancer, health insurance women, maternity, Medicare, Medicare Advantage, women’s health insurance

About Arlene Karidis

Arlene Karidis is a health reporter whose career spans two decades. A breast cancer survivor, Karidis says the Affordable Care Act is already helping many of the people who need it most, but that for many more Americans, the best of the reform law is…

Search within articles

Learn all about health insurance

what is cancer insurance

Will you need a cancer insurance policy?

While the Affordable Care Act has greatly expanded coverage for millions of Americans –…

HealthSourceRI Director works to persuade lawmakers to keep the exchange

Lawmakers in Rhode Island are considering whether or not to switch from the state run…

missed Obamacare enrollment deadline

Miss open enrollment? You’ve got options.

Now that open enrollment has ended – and the extensions have passed in most states –…

prescription drug local search

Save on prescription drugs close to home

The good news is that, whether you are insured or uninsured, anyone can utilize a few…


Qualifying events that can get you coverage

Even if you missed the general open enrollment, you could still have an opportunity to…

Will you owe an Obamacare Penalty?

Will you owe a penalty under Obamacare?

If, for whatever reason, you decide not to purchase coverage in 2014, you can use the…

STM: Short Term Medical

Short-term health insurance

Now that the 2014 Obamacare open enrollment period is over, a short-term policy will…

Health insurance for college students.

Student health insurance

Before college starts, students and their families need to ensure that their health…

Obamacare's essential benefits

Health reform’s 10 essential benefits

The ACA specifies ten benefits be included in all health insurance plans sold on each…

all posts

See all 46 articles

Related terms


Medicare is the federal health insurance program created to provide health coverage for Americans aged 65 and older…